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Claim by Michelle Scott Copyrighted August 17, 2020 City of Dubuque Consent Items # 2. City Council Meeting ITEM TITLE: Notice of Claims and Suits SUM MARY: Michelle Scott for vehicle damage and Donald J. Weig for vehicle damage. SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney DISPOSITION: ATTACHMENTS: Description Type Scott Claim Supporting Documentation Weig Claim Supporting Documentation ` � �°�:�t�� .;;, � a ;:��'`��%`�� 'i CLAIM AGAINST THE CITY OF DUBUQUE, IOWA ,':��'�a��'��.� � This written report constitutes your claim against the City of Dubuque, lowa. You should complete this form in fuil and attach any additional information that supports your claim. I „ The Claim must be filed with the City Clerk at City Hall, 50 W. 13th St., Dubuque, IA 52001. It !;! � will then be referred by the City Council to the appropriate department for investigation. I� Once that investigation is completed, a report and recommendation will be submitted to the i City Council. You will be provided with a copy of tha# report and recommendation. ;�, THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COIJNCIL. NO EMPLOYEE OF I'. THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPR�SENTATION TO YOU �f AS TO 'WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. I' ;; 1. Name of Claimant: mr C�p��.. 2. Address: , �(.�,� �, � �3� s��o�¢. �� CifiY�� State: '�� Zip: �;�C'�i� , 'i 'I� 3. Telephone Number: �� , �"( ��..�� 4. Date of Incident: _ `M�`��- ''�,.�� I,' i 5. Time of Incident: ��(`�� — � I � � � 6. Location of Incident (Be specific): �("`1� �,� ,�� . - �. ; ��[l�c�C � �' �$— �: 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give full details upon which you base your claim. If a City employee was involved, give the ! employee's name.) ! � �� & ; � � � ; p�� }` '�� .i� t"�,�r'. �� "i�^�� —�s ��e'1 � C.�r��r�,-� �'��, � �, � 8. What were weather conditions like? ''��.�i � `` .,,-- �� ;��,� I 9. Give name and address of any witnesses: 10. Did police investigate? (If so, give names of officers.) ' i � i , � 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). � �1� �� , '�r,��_c�� E � 9 i , . i 12. � I Was any damage d�ne to property. (If so, describe property and the extent of damages. Attach estimates of damages or describe basis for ascertaining extent of I'� damage.) , � � �� A ', —� �-� `l�c.�c�c� ��i�'1�— , ' 13. II'� What other damages do you claim, if any? ��`�q-1��Q� �� , � � �� . � � � ( p ��, ��t -� �� ,, 14. Have you been compensated for any part or all of your claim by any insurance company? (If so, give name and address of insurance company and amount paida) �� ' 15. What amount do you claim from the City of Dubuque? ' 16. Why do you claim the City of Dubuque is responsibl�? ' < 1 '� � 'I , ` `r� �p �C.��v� rv�:c��l', C�� .�� ,�,y�S° � �,� �_.t,��' �� ,'I 1�. H2ve vou r��c1� an� rla�m ar�a;�;c� �ny��y� �1J@ f;� ua�i�a��B� a� a i cSi.i'i vi i,ii� i►�LlCief�`i% I (If yes, give name and address.) �, � 'I 18. If the answer to Question 17 is yes, have you received any payment from that source, II'i and if so, in what amount? j Dated at Dubuque, lowa this � d�y �f , 2��2�3, I I � (Signature) ; ��C.�-��. ��- � - (Print Name) ; ; C� � ' �`�� - C� � � � � �° � � i (Rev. 5/18) �� . - �, � � � � � � � j ��' � � ,, ; , ; Confidential This communication and any attachments may contain information which is confidential '� and privileged by law and is for the use of the designated recipient. If you are not the �' intended recipient, you are hereby notified that you have received this communication in �� error, and that any review, disclosure, dissemination, distribution or copying of its contents � is prohibited. Please notify City of Dubuque immediately by telephone at (563)-589-4120 of i� your receipt of these items and destroy the communication and any attachments i' immediately. Further disclosure of this information may violate state and federal � restrictions. � � Confidential information may include the following: ; � 1) Social Security Number(s) 2) Medical/Health Information 3) Personnel/Disciplinary Information � 4) Bank Account Information �, 5) Financiallnformation !; 6) Credit Card Numbers ,; ii � If any documentation you desire to submit to the City of Dubuque contains any of the items above this cover sheet must be attached directly to the confidential information and indicate the type of ; information that is included. i' � � it � fj � 0� � ��- - ' � , hereby certify that the attached documents 'I inc ude the following protected information: ii Ili Social Security Number(s) Bank Account Infiormation ; l Medical/Health Information Financial Information � Personn�!lDiSci,�linary �n�ormatior� Credit Ca�-d Ncambe�(s) I understand that this information may be distributed within the City organization or to agents of the I City for processing and I hereby authorize the City to act accordingly taking all precautions to � protect my information from unnecessary distribution. � � � �,��"�' � � ignature Date . Copyrighted August 17, 2020 City of Dubuque Consent Items # 2. City Council Meeting ITEM TITLE: Notice of Claims and Suits SUM MARY: Michelle Scott for vehicle damage and Donald J. Weig for vehicle damage. SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney DISPOSITION: ATTACHMENTS: Description Type Scott Claim Supporting Documentation Weig Claim Supporting Documentation puhuque THE CITY ❑F � � �II-A�RNd Efh uB E ;;� � , I I MaS�"� 2eC� �Y� t�2 1�tSStSSI I zoa�•zoiz•zai3 YP pp zoi�*2oig TRACEY STECKLEIN '� PARALEGAL MEMO To: Mayor Roy D. Buol and Members of the City Council DATE: August 13, 2020 RE: Claim Against the City of Dubuque by Michelle Scott Claimant Date of Claim Date of Loss Nature of Claim Michelle Scott 08/13/20 08/10/20 Vehicle Damage This is a claim in which claimant alleges that during a windy storm event on August 10, 2020, a City tree fell onto claimant's vehicle which was parked at 1560 lowa Street. This claim has been referred to the lowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager John Klostermann, Public Works Director Tom Kramer, Urban Forester Michelle Scott OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 3O0 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563)583-4113/Fax (563)583-1040/EMai� tsteckle@cityofdubuque.org